• James Dunning, Raymond Butts, Ian Young, Firas Mourad, Victoria Galante, Paul Bliton, Michelle Tanner, and César Fernández-de-Las-Peñas.
• Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, University King Juan Carlos, Alcorcón, Spain.
• Clin J Pain. 2018 Dec 1; 34 (12): 1149-1158.

ObjectivesTo compare the effects of adding electrical dry needling into a manual therapy (MT) and exercise program on pain, stiffness, function, and disability in individuals with painful knee osteoarthritis (OA).Materials And MethodsIn total, 242 participants (n=242) with painful knee OA were randomized to receive 6 weeks of electrical dry needling, MT, and exercise (n=121) or MT and exercise (n=121). The primary outcome was related-disability as assessed by the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index at 3 months.ResultsIndividuals receiving the combination of electrical dry needling, MT, and exercise experienced significantly greater improvements in related-disability (WOMAC: F=35.504; P<0.001) than those receiving MT and exercise alone at 6 weeks and 3 months. Patients receiving electrical dry needling were 1.7 times more likely to have completely stopped taking medication for their pain at 3 months than individuals receiving MT and exercise (OR, 1.6; 95% confidence interval, 1.24-2.01; P=0.001). On the basis of the cutoff score of ≥5 on the global rating of change, significantly (χ=14.887; P<0.001) more patients (n=91, 75%) within the dry needling group achieved a successful outcome compared with the MT and exercise group (n=22, 18%) at 3 months. Effect sizes were large (standardized mean differences >0.82) for all outcome measures in favor of the electrical dry needling group at 3 months.DiscussionThe inclusion of electrical dry needling into a MT and exercise program was more effective for improving pain, function, and related-disability than the application of MT and exercise alone in individuals with painful knee OA.Level Of EvidenceLevel 1b-therapy. Prospectively registered February 10, 2015 on www.clinicaltrials.gov (NCT02373631).

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